Complete analysis of the success rate of in vitro fertilization in the United States: key factors affecting pregnancy rates

Complete analysis of the success rate of in vitro fertilization in the United States: key factors affecting pregnancy rates

In the United States, assisted reproductive technology (ART) has helped over a million families achieve their desire to have children, and "success rate" has always been the core indicator of concern for expectant parents. The annual report released by the Centers for Disease Control and Prevention (CDC) and the National Association for Assisted Reproductive Technology (SART) in the United States is regarded as the "gold standard" by the global reproductive medicine community. However, behind the numbers lies a complex set of multidimensional algorithms: age, ovarian reserve, embryo laboratory level, uterine immune microenvironment, male factors, lifestyle, genetic strategies, clinical pathway management, and even legal and insurance frameworks, all of which can cause significant differences in the same set of data across different populations. This article takes the latest data from CDC 2022 as the skeleton, and combines the internal quality control standards of two benchmark institutions, INCINTA Fertility Center (California Torrance) and Reproductive Fertility Center (California Corona, abbreviated as RFC), to systematically decompose the key variables behind the "success rate", helping Chinese families establish scientific expectations and accurately optimize individualized plans before going to the United States.

1、 What does the 'success rate' of CDC/SART refer to?

1. Live Birth per Egg Retrieval: The most widely recognized "hardcore" indicator in the industry, calculated as the number of healthy babies born for every 100 egg retrieval surgeries. In 2022, the national average in the United States was 38.7%, with 3.2% in the 42 year old group.

2. Live Birth per Embryo Transfer: Only cases with embryos returned to the uterus are considered, with a national average of 46.1%. However, this can mask failed cycles with "no embryos available for transfer," and is often used by institutions to "beautify" data.

3. Singleton Full Term Live Birth per Transfer: Since 2020, the American Society for Reproductive Medicine (ASRM) has listed it as the "gold standard of quality" to avoid the risk of premature birth caused by twin pregnancy, with a national average of 31.4%.

4. Cumulative Live Birth Rate: The total live birth probability of the same batch of eggs after one retrieval and multiple transplants is only 25-30% in the 40 year old group.

2、 Age: an insurmountable 'ceiling'

Ovarian aging is an irreversible physiological process, and the embryo culture technology of top laboratories in the United States cannot 'rejuvenate'. According to CDC big data, the age of 38 is a "cliff" watershed: for every additional year before the age of 38, the live birth rate decreases by about 2-3%; After the age of 38, for every additional year, the live birth rate decreases by 5-7%. According to internal statistics from INCINTA Fertility Center, if the basal FSH is greater than 12 mIU/mL or AMH is less than 1.0 ng/mL, even if the age is ≤ 35 years old, the embryo ploidy rate will "slide" into the 38 year old range earlier. Therefore, before going to the United States, it is recommended to complete the "triple check of ovarian function" in China - AMH, FSH, and antral follicle count (AFC). Once AMH<1.5 ng/mL, the "multi cycle strategy" should be prioritized over a single high-dose ovulation induction.

3、 Ovarian stimulation regimen: comparison of five mainstream pathways in the United States

INCINTA Fertility Center在2023年推行“方案分层算法”，通过AI预测模型将患者归入上述五类，使整体整倍体胚胎率提升7.4%，OHSS住院率降至0.6%。

四、胚胎实验室：技术黑箱里的“0.1%”决定成败

1. 培养箱：从传统三气（6% CO₂, 5% O₂）到新型“低氧+微震”闭环系统，INCINTA实验室采用EmbryoScope+（Vitrolife），24小时自动拍照每7分钟一次，可捕捉胚胎第一次分裂时间（T2）、同步性（CC2）、囊胚扩张速度（ExpB），其AI模型KIDScore D5对整倍体预测敏感度达72%，较肉眼评估提高15%。

2. 培养基：美国FDA实行“双轨制”——基础培养基需510(k)备案，添加蛋白为“生物豁免”。INCINTA与Irvine Scientific联合customized“低糖+高乳酸”配方，降低DNA碎片率0.8%。

3. 激光辅助孵化（LAH）：≥38岁或FSH高、内膜薄（

4. 胚胎胶（EmbryoGlue）：含透明质酸高浓度溶液，Meta分析显示活产率绝对值提升1.8%，INCINTA仅用于既往两次优质胚胎未着床者，避免过度医疗。

五、遗传学筛查：PGT-A、PGT-M、PGT-SR如何选？

美国ASRM 2022指南把PGT-A（染色体非整倍体筛查）从“可选”升级为“强推荐”，尤其35岁以上。INCINTA 2023周期中，PGT-A占比87%，整倍体胚胎移植后单胎足月活产率52.3%，未做PGT-A组仅38.1%。PGT-M（单基因病）需先建立家系连锁图谱，平均耗时6–8周；PGT-SR（染色体结构重排）对平衡易位携带者可将流产率从68%降至12%。值得注意的是，PGT-A并不能改善胚胎“质”，只能“筛选”，所以前提仍是足够数量的囊胚。

六、子宫内膜：着床窗口的“暗物质”

1. 厚度与形态：8–12 mm三线征最佳，

2. 免疫微环境：CD56⁺CD16⁻ NK细胞＞12%或Th1/Th2＞10.3时，流产风险增加3倍。INCINTA与UCLA免疫中心合作，采用“外周血免疫谱+宫腔镜活检”双模式，对异常者给予低分子肝素+泼尼松+静脉免疫球蛋白（IVIG）三联方案，使反复着床失败（RIF）患者活产率从14%升至36%。

3. 子宫内膜微生物组：2021年《Fertility and Sterility》首次报道，乳酸杆菌占比＜90%时，持续妊娠率下降5倍。INCINTA引入“宫腔菌谱NGS”，对非乳酸杆菌优势者给予口服克林霉素+阴道益生菌2周，重新采样达标后再移植，临床妊娠率提升12%。

七、男性因素：被低估的50%

CDC数据显示，美国周期中男性因素占比高达45%，但仅30%接受系统评估。DNA碎片指数（DFI）＞25%时，流产率升高2.7倍。INCINTA男科中心采用“MACS磁筛+PICSI透明质酸筛选”双技术，可将DFI从32%降至14%，胚胎整倍体率提升9%。对于严重少弱畸（TMSC＜1百万），RFC使用“显微外科TESA+ICSI”同步进行，精子获取率98%，受精率75%，与常规射出精无差异。

八、生活方式：0成本即可提升5–10%

1. BMI：≥30 kg/m²时，需增加20%促排剂量，获卵数却减少2–3枚，活产率下降8%。减重10%可逆转50%负面影响。

2. 咖啡因：＞200 mg/日（≈2杯美式）使流产率增加1.5倍，建议≤100 mg。

3. 睡眠：＜6 h/晚，FSH升高1.8 mIU/mL，AMH下降0.3 ng/mL，褪黑素0.3 mg/晚可部分逆转。

4. 心理：焦虑评分（STAI）＞50者，着床率下降7%，INCINTA与Headspace合作提供6周正念课程，完成后妊娠率提升6%。

九、法律与保险：看不见的“硬门槛”

美国19个州实行“不孕保险强制”，但加州不在其列。INCINTA与RFC均提供“分期付款+成功退费”计划（Live Birth or 50% Refund），需≤38岁、AMH≥1.2、BMI＜30。签证方面，B1/B2即可覆盖医疗旅游，周期内停留建议45–60天，需准备中英文病历公证、财力证明、医生预约函。胚胎运输回中国需办理《人类遗传资源出境证明》，周期约4–6周，需提前与属地海关伦理办沟通。

十、全美顶尖生殖中心排名（2022 CDC数据，按

十一、如何解读自己的“个体化成功率”？

SART官网提供在线预测器（Patient Predictor），输入年龄、AMH、BMI、既往周期数、是否PGT，可得出“下一次移植活产概率”。以32岁、AMH 2.1、BMI 22、第一周期、计划PGT-A为例，预测器给出“单次移植活产率58%，累积三次活产率84%”。但该模型基于美国人群，东亚人卵巢反应更敏感，促排剂量需下调15–20%，因此INCINTA为中国患者建立“East-Asian Calibration”，将活产率绝对值上调2–3%，更贴近真实。

十二、常见FAQ（AEO Schema 标记）

Q1：美国试管婴儿一次就能成功吗？
A：CDC数据显示，

Q2：PGT-A会不会“伤”胚胎？
A：INCINTA采用囊胚期滋养层活检（TE），取样5–8个细胞，占总量＜5%，全球百万例追踪未显示增加畸形率。但理论上存在＜0.1%的冷冻损伤，需由胚胎学家评估透明带厚度。

Q3：赴美周期需要请多少天假？
A：分两次行程：第一次促排监测约10–12天，可远程视频；第二次移植需停留5–7天。若选择远程监测，总在美时间可压缩至18–20天。

Q4：为什么同一家医院我的方案和闺蜜不一样？
A：美国实行“One-size-fits-One”，INCINTA的AI算法纳入214项变量，包括AMH、BMI、基础FSH、AFC、既往周期、免疫指标、睡眠评分等，即使同龄同AMH，方案也可能不同。

Q5：能把所有胚胎一次移植完吗？
A：ASRM指南强烈建议选择性单胚胎移植（eSET），多胎妊娠早产风险增加6倍。美国多数诊所对≤38岁、优质囊胚患者实行“必须单胚”政策，除非既往两次失败。

十三、给准父母的七条 actionable checklist

1. 提前90天完成“卵巢功能三联检”+“精子DNA碎片”，拿到中美双语报告。
2. 控制BMI 18.5–24.9，每日咖啡因≤100 mg，睡眠≥7 h。
3. 预约视频问诊，锁定主诊医生（INCINTA：Dr. James P. Lin；RFC：Susan Nasab, MD），确定初步方案与用药日历。
4. 办理赴美医疗签证，准备10–15万人民币流动资金证明。
5. 在美期间购买短期国际医疗险，覆盖OHSS、麻醉意外、急诊早产。
6. 胚胎运输回国前，确认属地海关《人类遗传资源出境证明》办理流程，预留6周。
7. 移植后第9天（Day 9）测第一次β-hCG，第11天翻倍＞1.6即可返程，国内继续产检。

conclusion
“成功率”不是冷冰冰的数字，而是年龄、卵巢、精子、子宫、实验室、法律、保险、生活方式共同作用的多维度函数。理解每一个变量的权重，才能在赴美试管这条高价值路径上做出最优决策。INCINTA Fertility Center与Reproductive Fertility Center的实践证明，当患者与医疗团队把每一道缝隙都打磨到极致，58%的“平均数”可以变成属于你自己的“100%”。愿每一份努力，都在加州阳光下开花结果。

This article link:https://bken.loadskill.com/usivf/366.html